伴有卵黄囊瘤成分的卵巢上皮性肿瘤临床病理特点分析

Clinicopathological features of ovarian epithelial tumour with yolk sac tumour component

目的总结分析伴有卵黄囊瘤成分的卵巢上皮性肿瘤病例的临床病理特征及诊断与鉴别诊断要点。方法和结果按病理诊断定义总结本文2例(其中,1例为会诊病例)及文献病例共35例,其中本院2例年龄分别为58岁和61岁。盆腔B超均显示为一侧附件区的囊实性占位,最大径分别为13.5 cm和12 cm,其中实性区直径分别为6.1 cm和6 cm。术前血清AFP分别为219.7 ng/ml和19000 ng/ml。2例均进行全子宫及双附件切除手术。大体检查显示一侧卵巢被囊实性肿物取代,实性区呈灰黄、灰褐色,可见坏死。镜下2例肿瘤组织均由2种成分组成,伴出血和坏死,一种成分为明确的卵巢恶性上皮性肿瘤(1例为透明细胞癌,1例为子宫内膜样癌);另一种成分为卵黄囊瘤成分,前者卵黄囊瘤成分呈网状及乳头状结构,可见S-D小体,后者表现为实性及腺样结构。免疫组化2例中卵巢癌成分CK7和EMA均为(+),AFP和SALL4均(-);2例卵黄囊瘤成分CK7和EMA均(-),AFP和SALL4均(+)。2种成分呈移行和重叠并存。结论伴有卵黄囊瘤成分的卵巢上皮性肿瘤少见,以老年妇女为主,患者常有血AFP水平不同程度增高。其中上皮性成分多为恶性。形态学结合血清学AFP改变及免疫组化CK7、EMA、AFP和SALL4可以确定诊断。准确的病理诊断是术后针对性治疗的关键,Ⅱ期及以上病例预后较差。

Objective To analyze the clinicopathological features of ovarian epithelial tumour with yolk sac tumour component（ OETYSC）. Methods and Results According to the pathological definition,we summarized 2 OETYSC cases in our hospital（ aged 58 years and 61 years,respectively） and 33 cases in literature. Pelvic ultrasound examination showed a large cystic-solid mass in one adnexa, respectively. The maximum diameter was 13. 5 cm and 12 cm,respectively,among which the diameter of solid area was 6. 1 cm and 6 cm,respectively. Preoperative serum AFP was219. 7 ng/ml and 19000 ng/ml,respectively. 2 patients both underwent complete hysterectomy and bilateral salpingooophorectomy. Gross examination showed large ovarian cystic-solid mass with obvious necrosis,and the solid area was grayyellow or gray-brown. Microscopically,2 cases were composed of two tumour components,with hemorrhage and necrosis.One component was malignant ovarian epithelial tumour（ clear cell carcinoma and endometrioid carcinoma,respectively）,another was yolk sac tumour with reticular pattern,papillary pattern,and S-D body in case 1,and glandular and solid pattern in case 2. Immunohistochemically,CK7 and EMA were both positive in the ovarian cancer component in 2 cases,but AFP and SALL4 were both negative. In the yolk sac component,CK7 and EMA were both negative,and AFP and SALL4 were both positive. Two components were transitional and overlapping. Conclusion OETYSC exists rarely,and mainly in older women. The serum AFP levels often increase with various degrees in the OETYSC patients. The malignant ovarian epithelial components often present. The correct diagnosis depends on the morphology,serum AFP levels and immunohistochemical markers,including CK7,EMA,AFP and SALL4. Accurate postoperative pathological diagnosis is the key to targeted therapy,and phase II or above cases have poor prognosis.